| National Provider Identifier [NPI]: | 1588661904 |
| Last Name Of The Provider | CAMPONOVO |
| First Name Of The Provider | ERNEST |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3700 PARK EAST DRIVE |
| Street Address 2 Of The Provider | SUITE 300 |
| City Of The Provider | BEACHWOOD |
| Zip Code Of The Provider | 441224399 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 182 |
| Number Of Services | 8757 |
| Number Of Medicare Beneficiaries | 6296 |
| Total Submitted Charge Amount | 888400 |
| Total Medicare Allowed Amount | 229740.55 |
| Total Medicare Payment Amount | 174556.29 |
| Total Medicare Standardized Payment Amount | 179559.78 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 182 |
| Number Of Medical Services | 8757 |
| Number Of Medicare Beneficiaries With Medical Services | 6296 |
| Total Medical Submitted Charge Amount | 888400 |
| Total Medical Medicare Allowed Amount | 229740.55 |
| Total Medical Medicare Payment Amount | 174556.29 |
| Total Medical Medicare Standardized Payment Amount | 179559.78 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 1010 |
| Number Of Beneficiaries Age 65 to 74 | 1998 |
| Number Of Beneficiaries Age 75 to 84 | 1888 |
| Number Of Beneficiaries Age Greater 84 | 1400 |
| Number Of Female Beneficiaries | 3607 |
| Number Of Male Beneficiaries | 2689 |
| Number Of Non Hispanic White Beneficiaries | 5145 |
| Number Of Black or African American Beneficiaries | 556 |
| Number Of AsianPacific Islander Beneficiaries | 62 |
| Number Of Hispanic Beneficiaries | 467 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 4566 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1730 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 38 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 55 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.8742 |